Phthalates are chemicals used in the manufacture of plastics, including food containers and personal care products such as shampoos and cosmetics. A growing body of evidence suggests that phthalates act as endocrine disruptors, and interfere with the signaling function of hormones in the body.

Researchers from New York University and the University of Iowa recently reported a study which found that phthalate exposure was responsible for about 100,000 early deaths among older Americans, and came with an economic burden four times higher than previous estimates. These findings are more evidence of the need for safer alternatives to phthalates and policies to reduce unnecessary exposures.

People who were between the ages of 55 and 64 and had the highest concentrations of phthalate metabolites in their urine were more likely to die of any cause than those with lower concentrations. They were also more likely to die of heart disease.

“Our research suggests the toll of phthalates on society is much greater than was first thought,” Leonardo Trasande, lead author on the study, told TheDoctor. “Limiting exposure to toxic phthalates can safeguard Americans’ physical and financial well-being.”

Data from over 5,300 adults 20 years old and older who participated in the U.S. National Health and Nutrition Examination Survey were analyzed for the study. Analysis was limited to those whose cause of death was tracked though the end of 2015.

The researchers focused on participants between the ages of 55 and 64 because previous studies had looked at the association between phthalate exposure and death in this age group. A little more than half of the participants from whom data were analyzed for the current study were women.

Participants provided urine samples for phthalate metabolite analysis. Those between the ages of 55 and 64 with the highest concentrations of phthalate metabolites in their urine were more likely to die of any cause than those with lower concentrations. They were also more likely to die of heart disease.

These findings support previous evidence of a strong association between phthalate exposure and death in adult men, particularly death from heart disease due to a decrease in testosterone levels. But the fact that women exposed to high levels of phthalates were also more likely to die and die of heart disease than those who were not suggests more than a decrease in testosterone levels may be involved, Trasande explained. “These chemicals were not designed with the human body in mind, they were designed with the products in mind.”

Data from the U.S. Centers for Disease Control and Prevention and the U.S. Census Bureau, as well as models from previous research, were used to quantify the economic impact of phthalate exposure. Previous studies linking more than 10,000 deaths per year among adult men to decreased testosterone levels caused by phthalate exposure estimated these deaths cost the U.S. economy almost $9 billion in lost productivity.

The current study dramatically raised the estimated impact of phthalate exposure on the U.S. economy to between $40 billion and $47 billion. “The fact that these effects, when identified in both men and women, increased the economic costs, and the fact that the costs were even greater, are both striking,” said Trasande, adding that it also refutes the argument that the cost of safer alternatives to phthalates is too great to even consider.

Keep in mind that the study does not demonstrate direct cause-and-effect between phthalate exposure and premature death; more studies are needed to better understand the mechanisms by which phthalates affect hormone regulation and cause inflammation in the body.

The study was published in Environmental Pollution.